Relationship Between Pretreatment Variables and Working Alliance in Psychotherapy: Parental Representations, Ego Functioning, and Psychopathology as Predictors

Abstract

The working alliance between patient and therapist is consistently documented as a significant predictor of psychotherapy outcome. Despite this finding, little is known about the patient pre-treatment variables that contribute to a positive working relationship. Among the variables that patients enter treatment is their attachment status, level of ego development, and pre-existing symptomatology. This study sought to understand the association between these variables and patients' perception of the early working alliance with young adults in an outpatient counseling center. To measure attachment status, Beth Hart's (1991) Internalized Parental Representations Scale (IPR) was administered at time of intake. Level of Ego Development was measured using Jane Loevinger's (1983) Sentence Completion Test which was also administered at time of intake. Diagnostic status and pre-existing symptomatology was assessed using the Personality Assessment Inventory (PAI). Patient's perception of the early working alliance was determined through their responses on the Working Alliance Inventory (WAI) which was given out following the third psychotherapy session. Results indicated no relationship between working alliance and attachment status and level of ego development. A significant negative relationship was documented between working alliance and depression, borderline features, paranoia, and somatic complaints. Implications, limitations and directions for future research are discussed. ^